Clinical care advice for monitoring of islet autoantibody positive individuals with presymptomatic type 1 diabetes

A Emile J Hendriks^{1

2}, M Loredana Marcovecchio^{1

2}, Rachel E J Besser^{3

4}, Ezio Bonifacio^{5

6}, Kristina Casteels^{7

8}, Helena Elding Larsson^{9

10}, Gita Gemulla^{5

11}, Markus Lundgren^{10

12}, Olga Kordonouri¹³, Roberto Mallone^{14

15}, Flemming Pociot¹⁶, Agnieszka Szypowska¹⁷, Jorma Toppari^{18

19}, Thekla von dem Berge¹³, Anette G Ziegler^{6

20

21}, Chantal Mathieu²², Peter Achenbach^{6

20

21}; INNODIA consortium, the Fr1da Study Group and the GPPAD Study Group

Collaborators, Affiliations

Collaborators

INNODIA consortium, the Fr1da Study Group and the GPPAD Study Group:
C Mathieu, P Gillard, K Casteels, L Overbergh, D Dunger, C Wallace, M Evans, A Thankamony, A E J Hendriks, S Bruggraber, M L Marcovecchio, M Peakman, T Tree, N Morgan, S Richardson, J Todd, L Wicker, A Mander, C Dayan, M Alhadj Ali, T Pieber, D Eizirik, M Cnop, S Brunak, F Pociot, J Johannesen, P Rossing, C Legido Quigley, R Mallone, R Scharfmann, C Boitard, M Knip, T Otonkoski, R Veijola, R Lahesmaa, M Oresic, J Toppari, T Danne, A G Ziegler, P Achenbach, T Rodriguez-Calvo, M Solimena, E Bonifacio, S Speier, R Holl, F Dotta, F Chiarelli, P Marchetti, E Bosi, S Cianfarani, P Ciampalini, C de Beaufort, K Dahl-Jørgensen, T Skrivarhaug, G Joner, L Krogvold, P Jarosz-Chobot, T Battelino, B Thorens, M Gotthardt, B Roep, T Nikolic, A Zaldumbide, A Lernmark, M Lundgren, G Costecalde, T Strube, A Schulte, A Nitsche, M Peakman, J Vela, M von Herrath, J Wesley, A Napolitano-Rosen, M Thomas, N Schloot, A Goldfine, F Waldron-Lynch, J Kompa, A Vedala, N Hartmann, G Nicolas, J van Rampelbergh, N Bovy, S Dutta, J Soderberg, S Ahmed, F Martin, E Latres, G Agiostratidou, A Koralova

Affiliations

¹ Department of Paediatrics, University of Cambridge, Cambridge, UK.
² Department of Paediatric Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
³ Diabetes and Inflammation Laboratory, Wellcome Centre for Human Genetics, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
⁴ Department of Paediatrics, University of Oxford, Oxford, UK.
⁵ Technische Universität Dresden, Center for Regenerative Therapies Dresden, Dresden, Germany.
⁶ German Center for Diabetes Research (DZD e.V.), Munich, Germany.
⁷ Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.
⁸ Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
⁹ Department of Pediatrics, Skåne University Hospital, Malmö/Lund, Sweden.
¹⁰ Department of Clinical Sciences Malmö, Lund University, Malmö/Lund, Sweden.
¹¹ Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
¹² Department of Pediatrics, Kristianstad Hospital, Kristianstad, Sweden.
¹³ Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany.
¹⁴ Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France.
¹⁵ Assistance Publique Hôpitaux de Paris, Service de Diabétologie et Immunologie Clinique, Cochin Hospital, Paris, France.
¹⁶ Department of Clinical Research, Translational Type 1 Diabetes Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
¹⁷ Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.
¹⁸ Institute of Biomedicine, Centre for Integrative Physiology and Pharmacology and Population Health Research Centre, University of Turku, Turku, Finland.
¹⁹ Department of Pediatrics, Turku University Hospital, Turku, Finland.
²⁰ Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany.
²¹ Technical University of Munich, School of Medicine, Forschergruppe Diabetes at Klinikum Rechts der Isar, Munich, Germany.
²² Department of Endocrinology, UZ Gasthuisberg, Katholieke Universiteit, Leuven, Belgium.

PMID: 38375753
DOI: 10.1002/dmrr.3777

Clinical care advice for monitoring of islet autoantibody positive individuals with presymptomatic type 1 diabetes

A Emile J Hendriks et al. Diabetes Metab Res Rev. 2024 Feb.

. 2024 Feb;40(2):e3777.

doi: 10.1002/dmrr.3777.

Authors

Collaborators

INNODIA consortium, the Fr1da Study Group and the GPPAD Study Group:
C Mathieu, P Gillard, K Casteels, L Overbergh, D Dunger, C Wallace, M Evans, A Thankamony, A E J Hendriks, S Bruggraber, M L Marcovecchio, M Peakman, T Tree, N Morgan, S Richardson, J Todd, L Wicker, A Mander, C Dayan, M Alhadj Ali, T Pieber, D Eizirik, M Cnop, S Brunak, F Pociot, J Johannesen, P Rossing, C Legido Quigley, R Mallone, R Scharfmann, C Boitard, M Knip, T Otonkoski, R Veijola, R Lahesmaa, M Oresic, J Toppari, T Danne, A G Ziegler, P Achenbach, T Rodriguez-Calvo, M Solimena, E Bonifacio, S Speier, R Holl, F Dotta, F Chiarelli, P Marchetti, E Bosi, S Cianfarani, P Ciampalini, C de Beaufort, K Dahl-Jørgensen, T Skrivarhaug, G Joner, L Krogvold, P Jarosz-Chobot, T Battelino, B Thorens, M Gotthardt, B Roep, T Nikolic, A Zaldumbide, A Lernmark, M Lundgren, G Costecalde, T Strube, A Schulte, A Nitsche, M Peakman, J Vela, M von Herrath, J Wesley, A Napolitano-Rosen, M Thomas, N Schloot, A Goldfine, F Waldron-Lynch, J Kompa, A Vedala, N Hartmann, G Nicolas, J van Rampelbergh, N Bovy, S Dutta, J Soderberg, S Ahmed, F Martin, E Latres, G Agiostratidou, A Koralova

Affiliations

¹ Department of Paediatrics, University of Cambridge, Cambridge, UK.
² Department of Paediatric Diabetes and Endocrinology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
³ Diabetes and Inflammation Laboratory, Wellcome Centre for Human Genetics, Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
⁴ Department of Paediatrics, University of Oxford, Oxford, UK.
⁵ Technische Universität Dresden, Center for Regenerative Therapies Dresden, Dresden, Germany.
⁶ German Center for Diabetes Research (DZD e.V.), Munich, Germany.
⁷ Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.
⁸ Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
⁹ Department of Pediatrics, Skåne University Hospital, Malmö/Lund, Sweden.
¹⁰ Department of Clinical Sciences Malmö, Lund University, Malmö/Lund, Sweden.
¹¹ Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
¹² Department of Pediatrics, Kristianstad Hospital, Kristianstad, Sweden.
¹³ Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany.
¹⁴ Université Paris Cité, Institut Cochin, CNRS, INSERM, Paris, France.
¹⁵ Assistance Publique Hôpitaux de Paris, Service de Diabétologie et Immunologie Clinique, Cochin Hospital, Paris, France.
¹⁶ Department of Clinical Research, Translational Type 1 Diabetes Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.
¹⁷ Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.
¹⁸ Institute of Biomedicine, Centre for Integrative Physiology and Pharmacology and Population Health Research Centre, University of Turku, Turku, Finland.
¹⁹ Department of Pediatrics, Turku University Hospital, Turku, Finland.
²⁰ Institute of Diabetes Research, Helmholtz Munich, German Research Center for Environmental Health, Munich, Germany.
²¹ Technical University of Munich, School of Medicine, Forschergruppe Diabetes at Klinikum Rechts der Isar, Munich, Germany.
²² Department of Endocrinology, UZ Gasthuisberg, Katholieke Universiteit, Leuven, Belgium.

PMID: 38375753
DOI: 10.1002/dmrr.3777

Abstract

Background/aim: Type 1 diabetes is an autoimmune disease that involves the development of autoantibodies against pancreatic islet beta-cell antigens, preceding clinical diagnosis by a period of preclinical disease activity. As screening activity to identify autoantibody-positive individuals increases, a rise in presymptomatic type 1 diabetes individuals seeking medical attention is expected. Current guidance on how to monitor these individuals in a safe but minimally invasive way is limited. This article aims to provide clinical guidance for monitoring individuals with presymptomatic type 1 diabetes to reduce the risk of diabetic ketoacidosis (DKA) at diagnosis.

Methods: Expert consensus was obtained from members of the Fr1da, GPPAD, and INNODIA consortia, three European diabetes research groups. The guidance covers both specialist and primary care follow-up strategies.

Results: The guidance outlines recommended monitoring approaches based on age, disease stage and clinical setting. Individuals with presymptomatic type 1 diabetes are best followed up in specialist care. For stage 1, biannual assessments of random plasma glucose and HbA1c are suggested for children, while annual assessments are recommended for adolescents and adults. For stage 2, 3-monthly clinic visits with additional home monitoring are advised. The value of repeat OGTT in stage 1 and the use of continuous glucose monitoring in stage 2 are discussed. Primary care is encouraged to monitor individuals who decline specialist care, following the guidance presented.

Conclusions: As type 1 diabetes screening programs become more prevalent, effective monitoring strategies are essential to mitigate the risk of complications such as DKA. This guidance serves as a valuable resource for clinicians, providing practical recommendations tailored to an individual's age and disease stage, both within specialist and primary care settings.

Keywords: monitoring; presymptomatic type 1 diabetes; primary care; screening; specialist care; staging.

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References

REFERENCES

1. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014;383(9911):69-82. https://doi.org/10.1016/S0140-6736(13)60591-7
1. Eisenbarth GS, Underhill LH. Type I diabetes mellitus. A chronic autoimmune disease. N Engl J Med. 1986;314(21):1360-1368. https://doi.org/10.1056/NEJM198605223142106
1. Gregory GA, Robinson TIG, Linklater SE, et al. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study. Lancet Diabetes Endocrinol. 2022;10(10):741-760. https://doi.org/10.1016/S2213-8587(22)00218-2
1. Greenbaum CJ. A key to T1D prevention: screening and monitoring relatives as part of clinical care. Diabetes. 2021;70(5):1029-1037. https://doi.org/10.2337/db20-1112
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Clinical care advice for monitoring of islet autoantibody positive individuals with presymptomatic type 1 diabetes

Collaborators

Affiliations

Clinical care advice for monitoring of islet autoantibody positive individuals with presymptomatic type 1 diabetes

Authors

Collaborators

Affiliations

Abstract

References

REFERENCES

MeSH terms

Substances

LinkOut - more resources

Full Text Sources